Mental Distress among Medical Students

*Syeda Rubaba Azim*

## **Abstract**

Depression, anxiety, and stress affect the mental health of an individual. Previous studies have shown high rates of depression, anxiety, and stress among medical students throughout the world. Medical students are future doctors, but mental distress among them has negative effects on their output, which ultimately affects patient care and quality of life. This chapter will discuss various reasons of mental distress among medical students and proposed solutions for the well-being of medical undergraduates like providing proper student support service and more opportunities for extracurricular activities.

**Keywords:** mental distress, medical students

### **1. Introduction**

The World Health Organization defines health as: "A state of complete physical, mental and social well-being and not merely the absence of disease" [1]. Many of us perceive health merely as being physical fitness and neglect the importance of mental health. Depression, anxiety, and stress levels are considered as significant pointers for the psychological well-being of the population. It is predicted that by the year 2020, depression will become the second most common reason of disability globally [2]. Failure to identify and cure of these mental disorders might have unwanted bearings on the lives of individuals [3].

Mental distress has been well identified in undergraduate medical students and is a matter of concern in both developed and developing countries [4]. The young students are the most susceptible group of the population to stressful life events, especially those who are pursuing a higher professional education in a competitive setting [5]. It is noted that medical undergraduates have higher levels of mental distress than the general population and their fellow peers [6]. Medical education encompasses challenging curriculum and clinical training [7]. The duration of the medical course is different across countries; some have 4-year graduate programs, and others have 5- or 6-year undergraduate programs [8]. The medical curriculum is usually divided into basic or preclinical (1st and 2nd years), clinical (3rd, 4th, and 5th years), and clinical house job (6th year) periods. The curriculum of preclinical phase focuses on basic medical science subjects, i.e., anatomy, physiology, and biochemistry, whereas the clinical phase emphasizes on clinical subjects, i.e., surgery, general medicine, pediatrics, community medicine, forensic medicine, and gynecology. In the clinical internship period, medical graduates have to rotate in different wards in the hospital and emergency units for 1 year under direct supervision.

Medical students learn specialized knowledge, skills, and attitudes which prepare them to become a competent physician; this highly demanding medical curriculum may have undesirable effects on the learner's physical and mental health [9, 10].

A high prevalence of stress, anxiety, and depression among medical students has been identified globally [11–14]. Medical education can cause a considerable amount of psychological stress on undergraduates [7]. Various psychological morbidities have been reported among medical students, ranging from stress, anxiety, social problems, depression, burnout, and suicidal ideation [15]. Due to the heavy educational workload in undergraduate medicine, medical students are more prone to psychiatric complaints such as depression, anxiety, and stress than their nonmedical peers [16]. Depression and anxiety in medical undergraduates can also continue during internship and residency periods and later in the medical professional life [9].

One of the major aims of medical education is to produce knowledgeable, skilled, and proficient doctors. The medical profession is considered as one of the prestigious professions in society. Students enter in the medical field for various reasons, including fulfilling their own passions, parental pressure, financial and job security, to secure a respected place in society, etc. [17].

Studies suggest that medical education may have an unintended harmful effect on students' mental health, resulting in high prevalence of depression, anxiety, and stress among medical students [10, 17–19]. It has been hypothesized that various factors are responsible for the decline in mental health of medical students, including academic pressure [20], increased workload [13], financial issues [20], sleep deprivation, and exposure to patients' suffering and deaths [7]. Mental distress adversely affects the learning and cognitive abilities of students [21] which might have an influence on their academic performance [10]. A study in the UK showed a high dropout rate in psychologically ill students [9]. It is crucial to recognize students' mental distress and their causes so that it can help the medical educationist to develop necessary amendments in the curriculum to ensure production of graduates who are emotionally fit for their difficult training to deal with various aspects of life like human suffering and death [17].

#### **2. Prevalence of depression, anxiety, and stress among medical students**

A widely distributed body of literature indicates that the prevalence of mental distress is increasing among students studying medicine [16, 20, 22]. It is evident that mental health problems are prevalent in the whole society, but university students are significantly more affected than the general population [14, 23]. This might be due to numerous challenges that university students have to face such as competition to succeed, high academic demands, teacher and parent's expectations, increased workload, financial problems, and apprehension about the future [24]. And among all university students, medical students exhibit higher mental distress than both the general population and their age-matched peers [20]. Worldwide medical undergraduates have been found at risk of mental distress and reduced life satisfaction [7, 24, 25]. Medical training involves many risk factors for mental illness, including academic burden, lack of sleep, minimal physical activities, and decreased time for social activities. A large study conducted in the USA, including six medical schools (582 students), concluded that when medical students enrolled in a medical institute, they had better or similar mental health than the general population. It shows that higher rates of distress reported in medical students are the result of the over-competitive training process of medical education that can have an unfavorable effect on the mental health of students [26].
